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MSK 1 > TMJ Exam and Inverventions > Flashcards

TMJ Exam and Inverventions Flashcards

1
Q

List some common functional limitations that may be observed in someone with TMD

A
  1. chewing
  2. eating
  3. talking
  4. sleeping
  5. work tasks (clenching with prolonged sitting for ex)
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2
Q

what should be included in the patient interview?

A
  1. History of Previous Injury (HPI)
  2. Primary (and secondary) complaints
  3. Associated symptoms
    1. HA (location, frequency, visual aura)
    2. Dizziness/Nausea (vertigo, lightheadness)
    3. Paresthesia/Anesthesia of face/scalp or body
    4. Tinnitus
  4. Special questions
  5. Previous intervention and response
  6. medication list
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3
Q

What special questions should be included in the pt interview?

A
  1. Joint noises
    • clicking/popping
    • crepitus
  2. Parafunction
  3. Locking
  4. Catching
  5. Hx of Open lock
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4
Q

List some outcome measures that you may include/see in a pt interview for someone with TMD

A
  1. PSFS
  2. Tampa Scale of Kinesiophobia for TMD
  3. Tempormandibular Pain Disorder Screening Instrument
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5
Q

What things should be included in the visual inspection of a pt with TMJ issues?

A
  1. Posture
  2. Craniofacial-specific observations
    • face type/shape
    • occlusion
    • facial symmetry
  3. Intra-oral inspection
    • scalloping
    • teeth
    • lesions
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6
Q

List several types of malocclusions that may be observed during the visual inspection

A
  1. Open Bite (space between front teeth when mouth is closed)
  2. Retrognathism (Overjet)
  3. Prognathism
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7
Q

Describe the proposed mechanism for forward head posture

A

passive tension by supra and infrahyoids alter resting position of the mandible

mandible is pulled inferiorly and posteriorly, changing position of the mandibular condyle on the cranium

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8
Q

List elimination tests that should be included for the TMJ

A
  1. UQS
  2. Initial TMJ screening
  3. Neuro screening tests
    • cranial nerve testing
    • test for UMN and LMN
  4. Other special tests
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9
Q

List special elimination tests for the TMJ

A
  1. Gross TMJ AROM
    • motions → opening, clenching, protrusion
    • symptoms → provocation of concordant pain
    • signs → joint noises, quality of motion, gross quantitiy of motion
  2. Cervical flexion and rotation test
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10
Q

how should you be positioned during AROM testing (structural stress testing) for the TMJ?

A

eye level at pt’s level of the TMJ

*assess pt’s comfortable starting position and take into account

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11
Q

what types of deviations should you be mindful of during AROM testing of the TMJ?

A
  1. C-type curve
  2. S-type curve
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12
Q

what motions are included in AROM and PROM for TMJ?

A
  1. Opening
  2. Protrusion
  3. Retraction
  4. Lateral deviation (bilateral)
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13
Q

List extra-oral palpation sites for the TMJ

A
  1. Temporalis
  2. Masseter
  3. Medial Pterygoid
  4. TMJ Joint line
  5. Supra-hyoids
  6. SCM
  7. cervical paraspinals
  8. Zygomatic arch
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14
Q

List intra-oral sites for palpation of the TMJ

A
  1. M/L Pterygoid
  2. Temporalis tendon
  3. Masseter
  4. Teeth
  5. Gum line
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15
Q

What directions are assessed with joint mobility testing of the TMJ?

A
  1. Cuadal Glide (inferior)
  2. Ventral glide (anterior)
  3. Medial glide
    • intra and extra oral
  4. Lateral glide
    • intra and extra oral
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16
Q

List confirmation tests for TMJ issues

A
  1. Auscultation of TMJ w/stethoscope during AROM
  2. Provocation Test
  3. Unilateral tongue depressor biting
17
Q

describe how to perform the provocation test

A

for retrodiscal material

unilateral in sequence → distraction, retrusion, cranial displacement, protraction

compression of intra-articular tissue between mandibular condyle and cranial articulation

18
Q

describe how results of the unilateral tongue depressor biting test can be interpreted

A

ipsilateral provocation → capsular

contralateral provocation → compression loading on intra-articular soft tissue structures

19
Q

List some intervention options for TMJ

A
  1. Pt reassurance and education
  2. Occlusal appliances
  3. Exercise
  4. Referral if appropriate
  5. Manual therapy
  6. Surgery
  7. Joint mobilizations
  8. Soft tissue mobilizations
20
Q

Pt education for TMD should include what?

A
  1. activity modification → avoid loading of the joint and control parafunction
    • sleep position, maintain resting position of TMJ, eating soft foods, avoid gum chewing
  2. Diagnosis, Prognosis, Goals, POC
  3. Relaxation techniques
21
Q

Exercise interventions for TMD can include what?

A
  1. Mid and lower trap/deep cervical flexor/thoracic extensor coordination training (postural exercises)
  2. Upper quarter stretching
  3. TMJ muscle coordination exercises (isometrics, biofeedback)
  4. TMJ ARM → maintain motion, reduce contracture, improve muscle function
  5. Neuromuscular control exercises for TMJ muscles
22
Q

What are the surgical options for TMD patients?

A
  1. Arthroplasty
  2. Orthognathic surgery

*~20% require surgical intervention

23
Q

what types of joint mobilizations could you peform for TMD?

A
  1. Oscillations
  2. Sustained holds
24
Q

what does research say in regard to manual therapy for TMD?

A

Level B evidence for manual therapy combined with exercises for trx of TMD, based on weak RCTs and case-series designs

25
Q

What types/direction of joint glides can be peformed for TMD intervention?

A
  1. Cuadal glide
  2. Ventral glide
  3. Medial glide
    • intra and extra-oral
  4. Lateral glide
    • intra and extra-oral

MSK 1 (17 decks)

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